More microinvasive foci in larger tumours of breast ductal carcinoma in situ

INTRODUCTION@#Microinvasion (Mi) is often thought to be an interim stage between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma. This study aimed to investigate the potential influence of Mi on survival and assess its correlations with clinicopathological parameters, prognosis and molecular markers.@*METHODS@#The number of Mi foci in a cohort of 66 DCIS-Mi cases was assessed from haematoxylin and eosin-stained sections. Disease-free survival, clinicopathological parameters and biomarker expression were correlated with the number of Mi foci.@*RESULTS@#Higher numbers of Mi foci were found in larger tumours (P = 0.031).@*CONCLUSION@#Greater extent of DCIS is associated with multifocal Mi.

The association between Betel Quid Chewing and Metabolic Syndrome among urban adults in Mandalay District of Myanmar / Journal of the ASEAN Federation of Endocrine Societies

Background@#As the prevalence of metabolic syndrome, obesity and diabetes increase worldwide, the need to identify modifiable lifestyle risk factors also increases, especially those that may be relatively unique to a specific population. To explore a possible association between betel quid chewing and metabolic syndrome, a community-based cross-sectional study was conducted.@*Methodology@#Three hundred ninety-one (391) adults were interviewed and the following parameters were measured: triglycerides, HDL-cholesterol, glucose, waist circumference, body mass index and blood pressure. Multiple logistic regression was used to determine the association between betel quid chewing and metabolic syndrome while controlling for confounders.@*Results@#The prevalence of metabolic syndrome was similar in chewers and non-chewers, 50% and 49%, respectively. After controlling for other factors, development of metabolic syndrome was positively associated with number of betel quid chewed per day, age greater than 40 years , and a positive family history of hypertension and diabetes. Regarding the duration of betel chewing, when analyzed by sex, the risk was doubled in men compared to non-chewers (OR 2.15; 95% CI = 1.21, 3.84]). As a result, a man chewing more than 10 pieces (OR 2.49; 95% CI = 1.36, 4.57]) of betel quids per day for more than 10 years had a two-fold increased chance of developing the metabolic syndrome.@*Conclusions@#Frequency and duration of betel quid chewing may represent a behavioral lifestyle target for approaches to reduce the incidence of metabolic syndrome.

Lower plasma selenoprotein P levels in regularly exercising young adults / Journal of the ASEAN Federation of Endocrine Societies

Objective@#Physical exercise can provide many health benefits in humans. Exercise-induced reactive oxygen species (ROS) formation and its downstream signaling cascades are reported to induce mitochondrial biogenesis in exercising tissues. Selenoprotein P (SELENOP) is the antioxidant hepatokine whose hypersecretion is associated with various metabolic diseases. It was reported to impair exercise-induced reactive oxygen species signaling and inhibit subsequent mitochondrial biogenesis in mice. However, the relationship between selenoprotein P and mitochondrial dynamics in humans has not yet been reported. While reduction of plasma selenoprotein P becomes an attractive therapeutic target for metabolic diseases, the role of regular exercise in this regard is still unknown. This study aimed to analyze the influence of regular habitual exercise on plasma selenoprotein P levels and its association with leucocyte mitochondrial DNA copy number in healthy young adults.@*Methodology@#Plasma selenoprotein P levels and leucocyte mitochondrial DNA copy numbers were compared in 44 regularly exercising subjects and 44 non-exercising controls, and the correlation between the two parameters was analyzed. Plasma selenoprotein P levels were measured by Enzyme-linked Immunosorbent Assay, and leucocyte mitochondrial DNA copy numbers were measured using the qPCR method.@*Results@#The regular-exercise group had lower plasma selenoprotein P levels with higher leucocyte mitochondrial DNA copy numbers than the non-exercise group. There was a tendency of negative correlation between the two variables in our studied population.@*Conclusion@#Regular habitual exercise has a beneficial effect on reducing plasma selenoprotein P levels while raising mitochondrial DNA copy numbers.

Validation of MyDiagnostick tool to identify atrial fibrillation in a multi-ethnic Asian population

INTRODUCTION@#MyDiagnostick is an atrial fibrillation (AF) screening tool that has been validated in the Caucasian population in the primary care setting.@*METHODS@#In our study, we compared MyDiagnostick with manual pulse check for AF screening in the community setting.@*RESULTS@#In our cohort of 671 candidates from a multi-ethnic Asian population, AF prevalence was found to be 1.78%. Of 12 candidates, 6 (50.0%) had a previous history of AF and another 6 (50.0%) were newly diagnosed with AF. Candidates found to have AF during the screening were older (72.0 ± 11.7 years vs. 56.0 ± 13.0 years, P < 0.0001) and had a higher CHADSVASC risk score (2.9 ± 1.5 vs. 1.5 ± 1.1, P = 0.0001). MyDiagnostick had a sensitivity of 100.0% and a specificity of 96.2%. In comparison, manual pulse check had a sensitivity of 83.3% and a specificity of 98.9%.@*CONCLUSION@#MyDiagnostick is a simple AF screening device that can be reliably used by non-specialist professionals in the community setting. Its sensitivity and specificity are comparable and validated across various studies performed in different population cohorts.

Delayed onset cerebral vasculitis from chronic Schistosoma mansoni infection in Myanmar: A case report

@#Neuroschistosomiasis is an infection of the central nervous system caused by Schistosoma species and constitute a severe manifestation of the disease. Schistosoma japonicum is well-known cause of cerebral schistosomiasis and Schistosoma mansoni for spinal schistosomiasis. Although neuroschistosomiasis is not rare, reports on cerebral vasculitis associated with Schistosoma mansoni infection is scarce. With regards to schistosomiasis in Asia, most of the published literature has been on Schistosoma japonicum and the prevalence of Schistosoma mansoni in Asia is not well established. We report here a 54-yearold Rakhine woman with history of diabetes mellitus for more than ten years presenting with three recurrent stroke occurring over 2 months, twelve months after returning to Yangon from Rakhine, an endemic area for Schistosoma mansoni infection. Cerebral MRA revealed beaded appearance along left ACA and segmental narrowing beyond terminal ICA both sides, and contrast enhancement was noted at left frontal lobe with restricted diffusion on MRI brain. Serum serology testing for Schistosoma mansoni infection was positive. With oral praziquantel and high dose corticosteroid, aphasia and swallowing improved. This is the first report of delayed onset cerebral vasculitis associated with chronic Schistosoma mansoni infection in Asia.

AFES A.S.-O.N.E.: ASEAN survey of needs in Endocrinologyin the time of the COVID-19 pandemic / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#The COVID-19 pandemic has made a major impact on hospital services globally, including the care of persons with diabetes and endocrine disorders. The aim of this study is to describe the epidemiology of COVID-19 in the ASEAN Federation of Endocrine Societies (AFES) member countries; to describe challenges, changes and opportunities in caring for patients with endocrine diseases, as well as in fellowship training programs, and endocrine-related research in the AFES countries.@*Methodology@#The AFES ASEAN Survey Of Needs in Endocrinology (AFES A.S.-O.N.E.) was an open-ended questionnaire that was sent to the presidents and representatives of the AFES member countries by email. Responses from Societies were collated and synthesized to obtain perspectives on the emergent issues in endocrinology in the Southeast Asian region during this pandemic.@*Results@#The burden of COVID-19 cases varied widely across the AFES member countries, with the least number of cases in Vietnam and Myanmar, and the greatest number of cases in either the most populous countries (Indonesia and the Philippines), or a country with the highest capability for testing (Singapore). The case fatality rate was also the highest for Indonesia and the Philippines at around 6%, and lowest for Vietnam at no fatalities. The percentage with diabetes among patients with COVID-19 ranged from 5% in Indonesia to 20% in Singapore, approximating the reported percentages in China and the United States. The major challenges in managing patients with endocrine diseases involved inaccessibility of health care providers, clinics and hospitals due to the implementation of lockdowns, community quarantines or movement control among the member countries. This led to disruptions in the continuity of care, testing and monitoring, and for some, provision of both preventive care and active management including surgery for thyroid cancer or pituitary and adrenal tumors, and radioactive iodine therapy. Major disruptions in the endocrine fellowship training programs were also noted across the region, so that some countries have had to freeze hiring of new trainees or to revise both program requirements and approaches to training due to the closure of outpatient endocrine clinics. The same observations are seen for endocrine-related researches, as most research papers have focused on the pandemic. Finally, the report ends by describing innovative approaches to fill in the gap in training and in improving patient access to endocrine services by Telemedicine.@*Conclusion@#The burden of COVID-19 cases and its case fatality rate varies across the AFES member countries but its impact is almost uniform: it has disrupted the provision of care for patients with endocrine diseases, and has also disrupted endocrine fellowship training and endocrine-related research across the region. Telemedicine and innovations in training have been operationalized across the AFES countries in an attempt to cope with the disruptions from COVID-19, but its over-all impact on the practice of endocrinology across the region will only become apparent once we conquer this pandemic.

Characterization of bacterial endophytes from Myanmar medicinal plants for antimicrobial activity against human and plant pathogens

This research aimed to investigate the antagonistic activity of the bacterial endophytes from Myanmar medicinal plants. Thirty-one bacterial isolates were isolated from Myanmar medicinal plants: Tinospora cordifolia (Wild.) Miers., Catharanthus roseus G. Don., Tectona hamiltoniana Wall. and Boscia variabilis Collett & Hemsl. (Capparaceae). Dual culture and agar well diffusion methods were used for antimicrobial assay. One endophyte from Catharanthus roseus and two bacterial isolates from Boscia variabilis Collett & Hemsl. (Capparaceae) had not only the antibacterial activity towards the human pathogenic bacteria but also the antifungal activity against the plant pathogenic fungi. From 16S rRNA sequencing, one strain from Catharanthus roseus G. Don. was Bacillus amyloliquefaciens DSM7 and two antagonistic strains from Boscia variabilis Collett & Hemsl. (Capparaceae) were Bacillus subtilis subsp. subtilis str. 168 and Bacillus amyloliquefaciens DSM7, respectively. The best medium for the maximum production of the bioactive compounds was Bacillus medium supplemented with the 4% of starch and 0.3% of peptone for B. amyloliquefaciens DSM7 and B. subtilis subsp. subtilis str. 168 showed the maximum antimicrobial compounds production when it was incubated in the medium amended with 3% of starch and 2% of peptone. The optimum conditions for the the maximum production of the antimicrobial compound were the medium pH of 6 at 35 ºC after two days of incubation for B. amyloliquefaciens DSM 7 and B. subtitlis subsp. subtilis str. 168 secreted the maximum concentration of the bioactive compounds at pH 7.5 and 35˚C on second day incubation period. In conclusion, the isolated endophytic bacteria showed the strong antimicrobial activity towards the pathogenic microbes and they could be used in medicine and agriculture as well.

Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn's disease?: a systematic review

Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn's disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn's disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn's disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC.

Comparison of the sensitivity and specificity of p16/Ki-67 dual staining and HPV DNA testing of abnormal cervical cytology in the detection of histology proven cervical intraepithelial neoplasia grade 2 and above (CIN 2+)

Introduction: Human papillomavirus (HPV) testing is used as a means of triaging cervico-vaginalsmears with low grade squamous abnormalities or as part of co-testing with cytology. While HPVtesting has a high sensitivity, it has a low specificity in detecting cervical intraepithelial neoplasiagrade 2 and above (CIN 2+) leading to unnecessary colposcopy referrals. We investigate the accuracyof the p16/Ki-67 dual immunocytochemical stain in determining the presence of CIN 2+ lesions onhistology and its potential as a superior biomarker for triage. Methods: Liquid based cervico-vaginalcytology specimens with squamous abnormalities and corresponding histology from 97 women withsubsequent colposcopy and biopsy were included. The specimens were then subjected to the dual stainand Roche Cobas 4800 multiplex real time PCR HPV DNA testing. The sensitivity and specificity ofthe dual stain and HPV testing were calculated using CIN 2+ on histology as a reference standard.Results: The sensitivity and specificity of the dual stain in detecting histology proven CIN 2+ was93.7% and 76.5% while HPV testing was 85.7% and 14.7% respectively. Of the 44 women withASCUS or LSIL on cytology, the dual stain also reduced the number of unnecessary colposcopyreferrals from 27 to 7 when used as a triage marker compared to HPV testing. Conclusion: p16/Ki-67dual stain was more sensitive and specific than HPV testing in determining the presence of CIN 2+on histology. It could triage low grade cervico-vaginal specimens more effectively and potentiallyhelp women avoid unnecessary colposcopies. Future studies are needed to further evaluate its rolein cervical cancer screening programmes.

Distant metastases in phyllodes tumours of the breast: an overview

Phyllodes tumours (PTs) of the breast are uncommon fibroepithelial neoplasms, comprising 0.3 ­ 1.0% of all primary breast malignancies in Western countries, but accounting for a higher proportion of primary breast tumours in Asian countries. They are graded as benign, borderline or malignant based on the World Health Organisation (WHO) classification, according to a constellation of 5 histologic parameters. While most PTs carry a good prognosis, malignant and occasionally borderline PTs have the potential to metastasize to distant sites. Although events of distant metastasis are few, the prognosis for such patients is dismal, as they are often unresponsive to chemotherapy with high mortality. This review seeks to provide an overview of this rare but important phenomenon of distant metastases in PTs of the breast (AU)

Role of the Whole Body Vibration Machine in the Prevention and Management of Osteoporosis in Old Age: A Systematic Review

A literature search of related articles was carried out in electronic data sources. Initially, 276 randomised controlled trials related to the title were collected, after which 44 were selected using the keywords. Overlapping articles, articles with a study duration of less than six months, and studies involving young participants were removed from the list. The remaining 20 articles were checked for entitlement using the PEDro scale. A total of nine eligible articles with 1486 participants were analysed. Seven trials used dual-energy x-ray absorptiometry (DXA) to measure bone mineral density (BMD). The six trials published from 2005 to 2013 found a significant increase in BMD. In the remaining one trial, there was no significant increase in BMD. One study published in 2013 reported a significant increase in BMD measured with peripheral qualitative computed tomography, whereas another trial published in 2014 stated that there was a reduction in calcaneal bone density measured by peripheral qualitative ultrasound. From these findings it can be concluded that the whole body vibration machine is a good adjunctive therapy for the prevention and management of osteoporosis in postmenopausal women. However, further investigations are necessary before the same can be recommended for elderly men.

HIV-Related Stigma and Discriminatory Attitudes among a Semi-Urban Population Running title: HIV-related Stigma and Discriminatory Attitudes

Background: Stigma and discriminatory attitudes (SDAs) have a negative impact on human immunodeficiency virus (HIV) prevention, testing, and treatment as well as on family and social networks. There is a lack of understanding about HIV-related SDAs among people living outside large cities. Objective: This study is aimed to determine the level of HIV-related SDAs among a semiurban population in Malaysia and to compare the SDA results among people with different sociodemographic characteristics. Methods: A sample of 106 respondents was generated by convenience sampling during the screening campaign in Alor Gajah, Malaysia. Data collection was carried out based on a pre-tested questionnaire via face-to-face interviews. Results: More than half of the respondents (62.3%) thought that an HIV-positive teacher should not be allowed to continue teaching at school; 81.1% were unsure or were unwilling to care for their family member with AIDS at home; 81.2% thought children with HIV/AIDS should not continue to be raised in families; and 77.3% thought they would not reveal if a family member had HIV/AIDS. Conclusion: Priority should be given to evidence-based interventions to reduce HIV-related SDAs. This study did not reveal any significant relationship between sociodemographic profiles and HIV-related SDAs. Therefore, further research with a larger sample size is needed to investigate the underlying causes of HIV-related SDAs.

The role of NS-1 antigen in early diagnosis of Dengue hemorrhagic fever in Yangon Children Hospital.

Detection of dengue virus NS1 antigen in patients’ sera serves as a supplementary assay for early diagnosis of dengue cases. This study evaluated the usefulness of NS-1 antigen for early diagnosis of dengue infection in children by use of a commercial immunochromato-graphic based SD Dengue Duo rapid test. The accuracy of SD Dengue Duo NS-1 antigen test was compared against a gold standard RT-PCR test in 117 children with suspected dengue infection attending YCH. All the children included in this study were tested for blood for complete picture and platelet count together with SD Dengue Duo rapid test. Among 117 samples, 65 serum samples were randomly selected and tested by RT-PCR. The sensitivity of SD Dengue Duo NS1 antigen assay was 40% (95% confidence interval) and specificity was 80% (95% confidence interval) as there were more secondary dengue cases in study population.The accuracy of NS1 antigen assay against RTPCR in patients with reduced platelet count showed that the sensitivity of NS1 antigen assay was 100% (95% confidence interval) and specificity was also 100% (95% confidence interval) when the platelet count was below 40,000.The result of this study demonstrated that the sensitivity and specificity of NS-1 antigen assay, at the time of low platelet count below 40,000, when specimens were collected within 5 days of fever, were relatively high compared to sensitivity and specificity of antibody detection. With the considerations for limitations such as NS1antigen assay being less sensitive in secondary dengue cases, in children, for diagnosis of dengue in early stage, with thorough clinical history and examination and also with platelet count, NS1 assay deserves inclusion in the diagnostic evaluation.

An anomalous pattern of superficial branch of radial nerve - a cadaveric case report / Patrón anómalo del ramo superficial del nervio radial - reporte de caso en un cadaver

In the present case study, there is an anomalous pattern of superficial branch of radial nerve (SBRN) that can be recognized as an anatomical variant of the left upper limb of a 60 years old donated embalmed male cadaver in the Department of Human Anatomy, Universiti Putra Malaysia, in which the superficial branch of radial nerve supplies the extensor carpi radialis longus and extensor carpi radialis brevis muscle. The superficial branch of radial nerve gave off branch to supply the proximal fusion part of extensor carpi radialis longus and extensor carpi radialis brevis muscles immediately after bifurcation of the radial nerve into the superficial branch of radial nerve and deep branch of radial nerve. This variation is very important to the surgeon as the presence of the variant will make them more careful in dealing with nerve entrapment surgery, reconstructive surgery and in the pain management services, the variation giving indications for treatment.

En el presente estudio se observó un caso de un patrón anómalo del ramo superficial del nervio radial (RSNR) reconocido como una variante anatómica del miembro superior izquierdo en un cadáver de sexo masculino de 60 años perteneciente al Departamento de Anatomía Humana de la Universidad Putra, Malasia. En este caso el ramo superficial del nervio radial inervaba a los músculos extensores radial largo y corto del carpo. El ramo superficial del nervio radial otorgaba un ramo a nivel del origen fusionado de los músculos extensores radiales del carpo, inmediatamente después de la división en ramos superficial y profundo del nervio radial. Esta variación es de importancia para el cirujano debido a que requiere un mayor cuidado en el tratamiento quirúrgico de atrapamiento del nervio o cirugía reconstructiva para el manejo del dolor.

Factors Affecting Nutritional Status of Children below 24 Months in Pekan District, Pahang, Malaysia

Introduction: This study aimed to assess the nutritional status of children below 24 months in the district of Pekan, Pahang, and identify the contributing factors. Methods: Using a cross-sectional methodology, a total of 910 children was selected by random sampling from four public health clinics. Anthropometric measurements were taken and weight-for-age, height-for-age, and weight-forheight were calculated in Z scores. Immediate caregivers of children were interviewed by using a pretested validated questionnaire to assess their socioeconomic, demographic, educational and occupational status. Results: Of the 910 children who participated in the study, the majority were Malay (70.1%), while the remaining comprised indigenous or Orang-Asli (OA) children. Prevalence of wasting, stunting and underweight were 28.7 %, 15.6 % and 19.0% respectively. There were more underweight males than females. Wasting was most common among children aged below 6 months. Stunting was more prevalent in children between 12 to 24 months. Obesity was seen in 7.3% of the sample. Maternal education, employment and socio-economic status had a significant influence on wasting and underweight. Children were vulnerable to stunting as age advanced, whereas prevalence of wasting tended to decrease. Conclusion: Malnutrition exists in significant proportions among children below 24 months in the Pekan district. This study identified low birth weight along with age, race, gender, large family size and socio-economic status as important risk factors of malnutrition.

Syndecan-1 is a potential biomarker for triple-positive breast carcinomas in Asian women with correlation to survival

<p><b>INTRODUCTION</b>While overexpression of syndecan-1 has been associated with aggressive breast cancer in the Caucasian population, the expression pattern of syndecan-1 in Asian women remains unclear. Triple-positive breast carcinoma, in particular, is a unique subtype that has not been extensively studied. We aimed to evaluate the role of syndecan-1 as a potential biomarker and prognostic factor for triple-positive breast carcinoma in Asian women.</p><p><b>METHODS</b>Using immunohistochemistry, staining scores of 61 triple‑positive breast carcinoma specimens were correlated with patients' clinicopathological variables such as age, ethnicity, tumour size, histological grade, lymph node status, lymphovascular invasion, associated ductal carcinoma in situ grade, recurrence and overall survival.</p><p><b>RESULTS</b>Syndecan-1 had intense staining scores in triple‑positive invasive ductal breast carcinomas when compared to normal breast tissue. On multivariate analysis, syndecan-1 epithelial total percentage and immunoreactivity score showed statistical correlation with survival (p = 0.02).</p><p><b>CONCLUSION</b>The intense staining scores of syndecan-1 and their correlation with overall survival in patients with triple-positive breast carcinoma suggest that syndecan-1 may have a role as a biological and prognostic marker in patients with this specific subtype of breast cancer.</p>

Calcium Intake among Myanmar Residing in Bago, Kayin, and Yangon Areas

A cross-sectional survey combined with 24-hour dietary recall and food diary was undertaken to assess the calcium intake of the Myanmar population. The study was conducted from November 2003 to October 2005. A total of 886 subjects of both sexes aged above 2 years from three States and Divisions (Bago, Kayin, and Yangon) of Myanmar were included in the study. The major measures were mean daily calcium intake (mg/day) and major sources of calcium in the diet. Overall mean calcium intake was 197+13mg/day (2-9 years), 421+2mg/day (10-19 years), 399+21 mg/day (20-49 years), and 383+25mg/day (>50 years) for males, while the corresponding values for females were 207+17 mg/day, 366+19 mg/day, 387+16 mg/day, and 327 +19 mg/day. Calcium intake was less than 80% of the recommended dietary allowances (RDA) for Myanmar for ages 2-9 years and 10-29 years in all the study areas, and for the 50 years and above age group in Yangon. Fish paste was found to be the major source of calcium. Milk and milk products contributed very little to total calcium intake, contributing 2.1% for residents in Yangon, 5.1% in Pa-an and none in Bago. Consumption of calciumrich foods, particularly milk and milk products, should be encouraged among the Myanmar people. Towards this end, appropriate nutrition education materials should be developed for promotional purposes.